Preventing a Preventable Cesarean

This year, one in three babies will be born by cesarean section. The cesarean rate in the United States has hit a historic high every year for nearly a decade, and shows no signs of abating. Research from the World Health Organization suggests that when a cesarean rate is higher than 15% in any population, cesarean surgery begins harming for women and babies than it helps. That means that each year, as many as half a million cesareans could be safely prevented in the U.S. each year.

These aren’t all unnecessary cesareans. By the time they’re performed, many if not most are necessary. But somewhere in the chain of events leading up to the cesarean there may have been a different policy, choice, or approach that could have prevented the need from arising in the first place.

There’s plenty we need to change about our system of care to lower the cesarean rate. But women themselves can make choices that optimize their chance of a safe, vaginal birth within our current system.

  • Choose a care provider and birth setting carefully. If you go to a hospital with a 70% cesarean rate, you’ll probably have a cesarean.
  • Do not agree to or ask for an induction of labor unless there is a valid medical reason. Carrying a big baby is not a valid medical reason. Inducing for this or another nonmedical reason may double the chance of a cesarean and doesn’t improve the baby’s safety.
  • Decline continuous fetal monitoring in labor unless you have pregnancy or labor complications that require its use. Continuous monitoring doubles the chance of cesarean and listening intermittently with a Doppler is just as safe for babies.
  • Have continuous labor support from a doula. Doulas increase the chance of having a vaginal birth, offer many other benefits, and have no risks. Some communities offer free or low-cost doula services. If you cannot afford to have a doula, learn ways you can get excellent support from the right friend or family member.
  • Learn about other labor practices that promote healthy labor progress, such as avoiding routine interventions, walking and moving around in labor, and pushing in an upright position.
  • Read more evidence-based ways to have a vaginal birth from Childbirth Connection.
Published on: November 03, 2009
About the Author
Photo of Amy Romano
Amy is a mother of two, a nurse-midwife, and an outspoken advocate for maternity care system reform. Since 2004, she has worked for Lamaze International to analyze, summarize, and critique research for childbirth educators, other birth professionals, and consumers.
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